Computer-aided endoscopic sinus surgery: a retrospective comparative study

Endoscopic sinus surgery [ESS], markedly improved with the introduction of new preoperative imaging techniques, intraoperative visualization tools, and the use of surgical navigation systems. In this retrospective study we evaluated the usefulness of CT-guided endscopic sinus surgery and studied its advantages over conventional endscopic sinus surgery. We retrospectively reviewed the records of 60 randomly chosen patients with chronic rhinosinusitis [CRS] and moderate-to-severe sinonasal polyposis, undergoing endoscopic sinus surgery with surgical navigation [n=30] and without navigation [n=30]. Data on the operative note, time of surgery, complications, and recurrence rate were collected and analyzed. Of the 60 patients, 40 [66.7%] were diagnosed with CRS and 20 [33.3%] had allergic fungal sinusitis. Primary surgery was performed in 37 [61.7%] and revision surgery was performed in 23 [38.3%] cases. The computer-aided surgery [CAS] group included 28 [93.3%] patients with extensive disease and 12 [40%] with bone erosions, with intraorbital or extradural extension, while the non-CAS group included 24 [80%] patients with extensive disease and seven [23.3%] with bone erosions, with intraorbital or extradural extension. The average operative time was approximately 13 minutes greater in the navigation group, with significant improvement in the recurrence rate [n=11, 36.7% in the non-CAS group; n=5, 16.7% in the CAS group], and intraoperative complications were fewer in the CAS group [two exposures of orbital fat in the non-CAS group; no complications in the CAS group]. Computer navigational systems appear to serve as a valuable adjunct in preoperative planning and safe intraoperative dissection

Nasal packing in cosmetic and functional nasal surgery

To evaluate the routine use of nasal packing after cosmetic and functional nasal surgery. Prospective collection from 2005 to 2006 at King Abdulaziz University Hospital in Riyadh for 54 patients post-septorhinoplasty with and without submucous diathermy or lateralization of inferior turbinate were evaluated for efficacy and complications of nasal packing which kept for different duration. All 54 patients had septoplasty, 21 with rhinoplasty, 12 with SMD, and 24 patients had inferior turbinate lateralization. Eight cm slim Merocel packed in 67 nasal cavity sides, 8 cm regular Merocel packed in 24 sides and 10 cm regular Merocel packed in 6 sides. Thirty-seven patients had the pack for 6 hours then removed and 17 patients had it for 24 hours. Forty-one patients with no significant discomfort, 13 patients with mild to moderate discomfort. Septorhinoplasty and SMD or lateralization of inferior turbinate can be managed without packing or any other hemostatic measures

Allergic fungal sinusitis in children in Saudi Arabia

To report the allergic fungal sinusitis [AFS] in children in Saudi Arabia and to review the experience of King Abdul-Aziz University Hospital in diagnosis and management of AFS in children. Hospital charts of 45 children reviewed retrospectively. Clinical presentation, radiological and operative findings, management and outcomes studied. Only 25 patients had >/= 4 diagnostic criteria, treated endoscopically between January 2000 and December 2005 and followed at least 2 years in XAUR, Ifoyacm, Kingdom of Saudi Arabia. Twenty-five patients had at least 4 criteria for AFS. All patients underwent functional endoscopic sinus surgery [FESS] with high recurrence rate, 44%. Twenty-eight percent needed revision surgery even with medical treatment post operatively. Moreover, no other complications were reported in this study. Aspergillus spp is the most common fungal type in our review. Allergic fungal sinusitis in children is underestimated and understudied associated with poor outcome and high recurrence rate because of difficulty m management. Therefore, the most effective approach of AFS management in children is to have a high index of suspicion, adequate preoperative evaluation, medical preparation preoperatively, meticulous surgery, medical management, postoperative including topical and systemic corticosteroids and close clinical follow-up with endoscopically guided debridement